Antidepressant didn't work? My approach as a psychiatrist

A framework for thinking through antidepressant non-response: when to optimize the dose, switch medications, or augment — and why the right move depends on whether you're dealing with partial response or no response at all. This video walks through how to evaluate whether an antidepressant trial was actually adequate, how to rule out pseudoresistance before calling something "treatment-resistant," and how to choose between switching and augmenting based on degree of response. It also covers augmentation options — including bupropion, mirtazapine, lithium, and aripiprazole — and the tradeoffs behind each. Made for PMHNPs, psychiatry residents, and prescribers looking to sharpen their clinical reasoning around antidepressant non-response and treatment-resistant depression. 00:00 – "Antidepressant didn't work" — why that's not enough 01:30 – Was the trial actually adequate? 02:49 – Ruling out pseudoresistance 03:43 – Optimize, switch, or augment? 04:38 – The switch vs. augment rule 05:56 – Choosing an augmentation strategy 08:10 – Lithium and antipsychotic augmentation 10:16 – Weighing tradeoffs, not just evidence 11:10 – When to widen the frame instead of adding more meds 12:08 – Four questions before the next step ⸻ Educational content for clinicians. Not medical advice or supervision, and not a recommendation for any specific patient. Cases discussed are composite, not real patients. For the fuller version — live case-based work, decision trees, and deeper frameworks — I run a clinical learning community called Confident Psychiatry: www.confidentpsych.com I'm Dr. Gerald Richardson, a board-certified psychiatrist. #psychiatry #pmhnp #treatmentresistantdepression #psychopharmacology #antidepressant